A 23-year-old woman developed biochemical signs of acute severe hepatitis together with confusion and flapping tremor after snorting a large dose of cocaine. Blood levels of cocaine were very high and liver biopsy performed few days later showed centrilobular necrosis. She recovered completely with conservative measures. Cocaine toxicity should be considered in similar cases of fulminant liver failure.

Adult↗

PubMed2001

[Upper digestive tract findings in elderly patients with iron-deficiency anemia. A comparison between users and non-users of non-steroidal anti-inflammatory drugs].

BACKGROUND: Iron-deficiency anemia is common in the elderly. Chronic upper gastrointestinal bleeding is its most frequent cause. The use of non-steroidal antinflammatory drugs (NSAID) is common in older people. Gastrointestinal complications of NSAID may be also more frequent among the elderly. AIMS: The study was aimed to evaluate if a history of regular NSAID use in elderly patients with iron-deficiency anemia is associated to characteristic findings on esophagogastroduodenoscopy. MATERIALS AND METHODS: A total of 91 patients (40% of males and 60% females) older than 65 years (mean age 77 years, range 65-90 years) entered the study. All of them had been admitted to our Hospital for study of iron-deficiency anemia. Thirty-eight patients were regular users of NSAID. Esophagogastroduodenoscopy was performed in all patients. RESULTS: The prevalences of peptic ulcer, erosive gastritis/duodenitis, and esophagitis were similar in NSAID users and non-users (13 vs 11%, 18 vs 15%, and 26 vs 26%, respectively). A trend to a higher prevalence of gastric adenocarcinoma was observed the group of NSAID non-users (8% vs 23%, p = 0.05). Esophagogastroduodenoscopy was entirely normal in 39% of NSAID users and 34% of NSAID non-users. CONCLUSIONS: Upper gastrointestinal lesions in elderly patients with iron-deficiency anemia are similar in NSAID users and non-users, with the exception of gastric adenocarcinoma which can be more common in NSAID non-users.

Aged↗

PubMed1996

[Bacteremia and endocarditis caused by Streptococcus bovis in patients with alcoholic hepatopathy without evidence of colonic pathology].

The association of Streptococcus bovis bacteremia and endocarditis with colonic pathology, mainly neoplastic, is well known. Its relationship with liver disease without evidence of gastrointestinal disease has been rarely described. To analyze the association between S. bovis infection and liver disease, positive blood cultures for this microorganism in hospitalized patients in the Internal Medicine and Gastroenterology Departments from December 1993 until October 1995, have been reviewed. Three cases of S. bovis infection (one bacteremia, two endocarditis) were found. Alcoholic liver disease was diagnosed in all three patients, with associated hepatitis C virus in one of them. Colonic pathology was excluded by colonoscopy and/or barium enema. Other gastrointestinal disorders were excluded by means of gastroscopy, barium gastrointestinal study and abdominal ultrasonography. Antibiotic therapy was based in betalactamics, with associated aminoglycoside in two cases. One patient needed aortic and mitral valve replacement and another one needed orthotopic liver transplantation. No new gastrointestinal pathology emerged in the follow-up (5-23 months). Cases of S. bovis bacteremia and endocarditis should be screened not also for colonic pathology, but also for liver disease, particularly in alcoholics.

Adult↗